Analysis: Big benefits for seniors in 'human infrastructure' proposals
October 1, 2021 | View PDF
Making omelets for a group of people is often a messy process, inevitably breaking a lot of eggshells. Ingredients can be changed hundreds of ways to experiment and adjust flavors.
Ultimately, if it’s done well, the result is a delicious omelet concoction at the end of the kitchen adventure.
Democratic lawmakers on Capitol Hill are attempting to make legislative omelets with numerous committees getting their hands in the mix – and lots of eggs are getting broken along the way as they work to pass the most ambitious domestic agenda in more than 50 years. In what will be a huge expansion of the nation’s safety net, Democrats are trying to do this without Republican help, at the same time as they have the smallest margin of Congressional control in two decades.
This is happening with two different legislative packages –an infrastructure bill, where some Republicans are joining Democrats to fix the nation’s crumbling bridges and roads – and a budget framework, which President Joe Biden calls his “human infrastructure” package, where Democrats will have to be completely united to shepherd the huge, detailed proposals through both chambers, without a single Republican vote.
The budget package is essentially Biden’s economic agenda, designed to remake broad swaths of the American economy. It pledges to expand Medicare, commit significant new money to combat climate change, raise taxes on the wealthy, and boost federal programs that aid low-income families and children, including paid leave and a direct cash allowance for raising children, which was approved temporarily in the coronavirus funding bills that lawmakers now want to make permanent.
But it will need to run the gauntlet, getting attacked, twisted and adjusted to get through the House, the Senate and finally signed into law. As it moves through each phase, no one knows what the final legislation will look like. It’s going
to take a while to play out and what emerges at the end may not resemble what things look like at this moment in time. Democrats have set self-imposed September deadlines, but inevitably, Congress being Congress, things will take perhaps until November to work out all the details.
Democrats hope the final result will be a law that promotes economic growth, with childcare subsidies that get parents back into the workforce, education spending to more equitably prepare all Americans to work, and job training to improve labor mobility. The proposal doesn’t create many new programs, but expands and re-orients funds toward Democratic priorities. However, to Republicans, the Democrats’ plan is nothing short of socialism. GOP lawmakers say they are concerned that the plan is financially unsustainable and would undermine economic growth, by rendering Americans too dependent on the government for their basic needs.
What’s possible for seniors?
What the bill contains is vital for seniors. It is the vast majority of the healthcare blueprint Biden campaigned on in his race for the White House. Here are some of most important areas:
Medications. It would attempt to lower drug prices, in part, by allowing Medicare to negotiate drug process and impose penalties on drugmakers that hike prices faster than inflation.
Medicare. It would also, for the first time, expand Medicare to include dental, vision and hearing benefits – which private Medicare advantage plans do, but traditional Medicare has never done – as well as lower the eligibility age down to as low as 60. It’s unclear if any or all of these plans will make the final legislation. Nearly half of Medicare beneficiaries, or 24 million people, did not have dental coverage, as of 2019, according to a recent Kaiser Family Foundation report.
Health insurance subsidies. The legislation would also extend the enhanced Affordable Care Act subsidies contained in the coronavirus relief bill Congress passed last spring. Those subsidies reduce the amount Obamacare enrollees have to pay to no more than 8.5% of their income – particularly useful for frail elderly Americans – and make assistance available to more Americans.
In-home services. The proposal also could help older folks who live in their homes, by larger investments in home and community-based services and for home-care workers. Biden had tried, unsuccessfully, to include those in his roads-and-bridges infrastructure bill, but that was rebuffed. But it is part of the proposed human infrastructure package.
Medicaid expansion. The legislation also calls for creating a new federal health program for Americans who live in states that have not expanded Medicaid under the Affordable Care Act. A dozen states have yet to do so. More than 2 million low-income adults fall into that coverage gap.
To pay for all of these huge programs, Democrats are pushing a series of tax increases on upper-income earners, specifically those earning over $400,000 a year – and corporations to pay for the bill. It will likely also include changes in how estates are taxed so that heirs must pay more taxes on inherited assets, which is particularly important to wealthy seniors.
The political potholes
This legislative concoction is one of the greatest political gambles of recent times, playing out in front of everyone. Democrats argue that bigger is better – and the ever-changing price tag on these packages are in the trillions with a ‘T’ – of dollars. But even Democrats are sharply divided on just how big is enough. Where they are united, however, is on the desperate need to re-weave the social safety net, after decades of expanding income inequality, stagnating wealth and depleted government resources, especially in the light of the worst public health crisis in a century.
But what succeeds legislatively may not be what succeeds politically. The one inflexible deadline is the November 2022 mid-term elections. Congressional Democrats will have to campaign on what they’ve accomplished and so far in Biden’s term – that’s coronavirus funding, which has yet to fully fix that issue. Democrats have had virtually no other major accomplishments. The underlying dynamic is that this may be the party’s one and only chance to make a big mark before they potentially lose power in Washington.
To get these infrastructure bills passed, Biden and the Democrats have no room for error. In the Senate, Democrats possess only a tie-breaking majority at 50-50. So, they are confronting the reality that they may have to compromise some of their own ambitions, not to overcome opposition from Republicans, but rather to quiet dissent among their own ranks. Think of it as a multi-dimensional chess match with several opponents, who are also allies.
How lawmakers succeed will depend on how well lawmakers can construct their legislative omelets. Watch for a lot of broken eggs.